Using data from the KNHANES, this study demonstrated that socioeconomic factors affect breastfeeding. Children whose mothers have a higher education level, middle high income, no smoking and obese status were associated with breastfeeding, as were children whose fathers had high education level and 30s age.
Multiple factors influence breastfeeding. These factors were classified into four groups: demographic, biological, social, and psychological.13 Demographic factors that affect the breastfeeding rate include race, maternal age, marital status, socioeconomic status, and education level.13 In this study, we examined socioeconomic factors that affect breastfeeding.
Some studies showed that parental age did not affect breastfeeding.14,15 However, several previous reports showed that the older the mothers were more likely to breastfeed than were younger mothers.16-18 Oakely et al19 reported that the younger the mother was, the less likely she was to breastfeed or to stop breastfeeding within 6 weeks. We posit that younger mothers lack knowledge and awareness of breastfeeding. In this study, most parents were in their 30s and most breastfed their infants; mothers’ age did not affect breastfeeding.
Banu et al20 stated that the higher the parents’ education level, the higher the exclusive breastfeeding rate and longer duration of the exclusive breastfeeding. In this study, parents’ education level was also related to breastfeeding. The higher the parents’ education level, the more it affected breastfeeding. It is believed that the higher education level coincides with increased opportunities to access information about the benefits of breastfeeding. In high-income countries, mother’s education level is positively associated with higher breastfeeding rate.16,17,19,21-25 Even for mothers with a job, breastfeeding rate is estimated to be high, because the higher the level of education, the higher the occupational status, the better the working environment and the better knowing the benefits of breastfeeding. In middle- and low-income countries, the relationship between breastfeeding and mothers’ education level varies. Some studies have reported a negative relationship between mothers’ education level and the breastfeeding rate owing to quick return to work. 18,26 Another study showed a higher parental education level was associated with a higher breastfeeding rate and exclusive breastfeeding.27 We found a positive association between father’s education level and breastfeeding. Similar finding has been reported by Flacking et al 28, who found that the lower the fathers’ education level, the lower the breastfeeding rate. We posit that this is related to family income. Because higher education often results in a better income, mothers may not need to work and can focus on parenting. However, other study showed that mothers’-but not fathers’- education level was related breastfeeding,17 or that parental education level was not related to breastfeeding. 29,30
Wallby et al31 reported that higher breastfeeding rate in low-income households. This is believed to be due to the fact that there are no economic condition to choose a different formula besides breast milk and no easy finding a job for mother. Victoria et al 4 stated that high-income, better-educated women breastfeed more commonly in high-income countries. Due to economic benefits, the lower the household’s gross income, the higher the breastfeeding in low-income and middle-income countries. However, in other studies, household income did not affect breastfeeding. 15, 29 In this study, there was no relationship between house income, the parental income and breastfeeding, however, the mothers of middle high income was related to breastfeeding.
Maternal job status is variable that has been associated with breastfeeding. Previous studies 14,18,24 revealed that full-time houseswives have higher breastfeeding rates than mothers with work and the shorter the time to return to work after childbirth, the shorter the breastfeeding period. It is estimated that they stop breastfeeding because they have less time to care for the child while working. However, we did not find a significant association between breastfeeding and parental job status.
A consistent negative association between breastfeeding and maternal smoking has been well known in present study.13,32 Weiser et al33 showed that smoking during the postpartum period were associated with failure to initiate breastfeeding, also associated with weaning sooner. Nicotine increases dopamine secretion in the hypothalamus, thereby reducing prolactin levels.34 For this reason, helping mothers quit smoking is beneficial to the health of infants and children as it helps prolong breastfeeding duration. In our study, significant negative association with breastfeeding was observed for maternal smoking.
Baker et al 35 suggested that maternal obesity can be considered as a risk factor to adverse breastfeeding outcome. There were some hypotheses trying to explain possible reasons why obese women are less likely to breastfeed; (1) large breast in obese women have been associated with breastfeeding practical difficulties; 36 (2) excessive maternal adiposity may interfere with the development of the mammary glands;37 (3) delayed lactogenesis and lower prolactin response to suckling in obese women.38 Our result showed that obesity is associated with breastfeeding. But we were not clear on the possible reasons.
Importantly, our results shed light on some socioeconomic factors associated with breastfeeding; however, this study has some limitations. The utilized data were collected through self - report, and this is a source of recall bias which may have either underestimated or overestimated the relationship between the breastfeeding and socio-economic status. This study was conducted by breastfeeding status, it was not possible to investigate the effects of breastfeeding duration and type. Further, causal relationships cannot be confirmed owing to the cross-sectional design of the KNHANES. In addition to the factors used in this study, it is considered that studies on various social factors such as breastfeeding education, use rooming-in, use of postpartum care center, parental leave, and establishment of a breastfeeding room in the workplace are necessary.